středa 17. března 2021

Michel Odent Midwifery in the future

If we want to find safe alternatives to obstetrics, we must rediscover midwifery. To rediscover midwifery is the same as giving back childbirth to women.
And imagine the future if surgical teams were at the service of the midwives and the women instead of controlling them. Michel Odent

pátek 5. března 2021

 

Vzkaz anglické princezny Anny

ženám 



Princezna Anna  se věnuje řadě charitativních činností dlouhá léta. Je silnou osboností královské rodiny. 


Přišla také pozdravit ICM kongres a porodní asistentky v Glasgow 2006


Glasgow 


Před jejím příchodem  jsme byly informovány Malcolmem/  naším hlavním managarem kongresu/, že máme udělat tzv. pukrle..... bylo mi ctí princezno Anno, vzájemně jsme se na sebe usmály.

VZKAZ princezny Anny, která se účastnila řady charitiativních akcí a je členkou mnoha mezinárdních organzací pro pomoc ženám a dětem zní:


Pokud chcete pomoci dětem :

vzdělávejte  jejich  matku v těhotenství, při porodu a v mateřství!


 Jak velká událost to byla si znovu uvědomuji při pohledu na obrázek.


http://www.vialucis.cz/Obsah.htm


úterý 2. března 2021

Porodnice - vždy byla možným místem infekce


Nemocnice - Porodnice vždy byla potenciálním místem nosokomiální či jiné  nákazy  pro ženu nebo dítě.


A že bývaly.....    horečka omladnicv 18 století , rozpadlé stehy na hrázi a rozpadlé hráze jako takové,  zhnisaná břicha po císařských řezech, infekce břišní, komplikace močového a infekce močového ústrojí,  zanícená prsa ve 20. století,  a dlouhé týdenní hospitalizace bez jakékoliv návaznosti na péči v domácnosti. 

Ženy setrvávávaly v porodnicích 7 až 14 dnů.

Používaly se hojně antibiotika.


Nyní se k tomu přidal Covid a na něj žádná antibiotika nejsou. 

Potřebujete klid, potřebujete čistý vzduch, pocit jistoty...........







Nejlepší je vždy PREVENCE


Jak na to:

Dodržujte následující:

snažte se být v  porodnici nebo nemocnici co nejkratší dobu, vyhledejte si porodní asistentky pracující v terénu - je to porodní asistentka,  která pracuje tzv. na IČO a je registrována,  čím blíže k bydlišti tím lépe, nejlépe okolo 16. týdne těhotenství, lze  se však objednat  v jakékoliv týdnu těhotenství.

Vyhledejte pediatra.
Zeptejte se svého  gynekologa, jak Vám může být nápomocen v této době?
Můžete zároveň docházet k lékaři - gynekologovi a také k porodní asistentce. 
Jsou lékaři  otevřeni  mezioborové spolupráci? Ptejte se. 

Porodní asistentka Vás  odborně i lidsky provede těhotenstvím, dostanete správné tipy ve správný okamžik, odborně Vás vyšetří, tak jak je k tomu vyškolena, případně Vás doporučí k nějakému dalšímu odborníkovi.
Porodní asistentka je vyškolena pro práci v terénu, provádí těhotenskou poradnu, zjistí, kdy porod začal a kdy máte odjet do porodnice, kdyby porod byl překotný,  ví co má dělat.


Porod 
Porodní asistentka Vás připraví na porod, budete vědět, jak se na porod připravit, kdy ji telefonovat, jak si si počínat v ranné fázi porodu.
Porodní asistentka zjistí v jaké fázi porodu jste a ve správném momentu Vás přetransportuje do porodnice - nemocnice.

Těhotná žena má dorazit po porodnice, když je k porodu nachystaná tj. branka je otevřena u primary na 5 cm a u vícepary na 7 cm.  Záleží jak porod začne, aby začal kontrakcemi, tj tzv .fyziologicky na to  dá porodní asistentka mnoho tipů. Z hygienických i provozních důvodů je vstup na porodní sál optimální tak jak uvádím. 
K tomu, aby žena dorazila do porodnice v tuto chvíli  - je potřebná porodní asistentka. 

Využijte možnosti ambulantního porodu! Odejděte domů,  jak to jde nejdříve !
Ptejte se v porodnicicích, jak jsou tomuto dřívějšímu odchodu vštřícni a jak Vám mohou pomoci. 

Snížíte počet lidí - kteří se starají o Vás i o Vaše dítě!!!!
Snížíte možnost nákazy pro Vás i Vaše dítě. 

Porodní asistentka Vám pomůže s péčí o Vás o i Vaše dítě ve vašem domácím prostředí,  dítě zkotroluje, zváží, zjistí zda je dítě dobře kojeno a zda prospívá tak jak má.
Ptejte se pediatra, zda Vás navštíví doma. 

Porodní  asistentka prohlédne i Vás, jak se Vám po porodu daří. 
Má veškeré vybavení  potřebné  k  těhotenské, porodní i poporodní péči v domácím prostředí. 



https://drive.google.com/file/d/1oEeK2cRaCzK-gfKylij0jWk66H1PVcwN/view?usp=sharing









čtvrtek 25. února 2021

 

Labor Care Guide WHO 

                                                                                    2020 

Nový manuál odborné  péče během porodu 

2020


V tomto manuálu je brán zřetel na předchozí publikaci Péče během porodu pro  pozitivní zážitek ženy, která  vyšla v roce 2018.

https://apps.who.int/iris/bitstream/handle/10665/272447/WHO-RHR-18.12-eng.pdf?sequence=1


Jako zásadní WHO mění vyplňování klasického  partografu - který se užíval asi 70 let - a vytvořilo  nový Itinerář porodu, který posuzuje a zapisuje další faktory, které mají vliv na porod a již nelpí na tom, aby se žena tzv .otevírala povinně 1 cm za 1 hodinu. 

Vše se velmi rychle mění a je potřeba být na vše přípraven. 

Dalo by se říci, že  se v tomto manuálu  konečně zohledňuje porodní děj jako komplexní a multifaktorový proces ženy a dítěte, které se má narodit a také více jako podpora rodu, kterému jako zdravotníci sloužíme. 

Nový manuál najdete na této aplikaci:

https://apps.who.int/iris/bitstream/handle/10665/337693/9789240017566-eng.pdf


This manual takes into previous publication Childbirth as a Positive
a Positive Birth Experience published in 2018. As a major, the WHO is changing the filling of the classical partographer - who has been using it for about 70 years - and has created a new birth itinerary that assesses and records other factors that affect childbirth and no longer insists that a woman must open 1 cm in 1 hour. Everything changes very quickly and you need to be prepared for everything. It could be said that finally, the birth history takes into account the complex and multifactorial process of women and children who have birthdays and also more as a support for the family they serve as health professionals.
New manual you will find this application:https://apps.who.int/iris/bitstream/handle/10665/337693/9789240017566-eng.pdf








pondělí 25. ledna 2021

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Position Statement: Midwifery units and COVID-19 For release on 31st March 2020

Midwifery units (MUs) can make a positive contribution when NHS maternity services are stretched to the limit by the effects of Covid-19. The Midwifery Unit Network (MUNet) is committed to supporting NHS senior managers and frontline staff by collaborating in the pursuit of constructive solutions to the current unprecedented challenges.

MUNet is concerned about the care options available for women with uncomplicated pregnancies or those who prefer an out-of-hospital birth. During the COVID-19 pandemic, health systems all over the world are stressed to their maximum capacity by increased workloads and lack of staff due to sickness. The population is advised not to attend a hospital setting unless strictly necessary, yet this advice seems to apply to all but healthy women during childbirth. Throughout this crisis, women will continue to be pregnant and give birth, deserving the same right to safe maternity services and compassionate care as they always have (1).

Hospital facilities are at high risk of being contaminated with Covid-19 as a significant but unknown percentage of carriers are asymptomatic. Furthermore, NHS staff who may have been exposed to the virus, have limited access to diagnostic testing and PPE equipment. Skilled and dedicated healthcare staff are overworked, and units understaffed.

Midwifery units, also known as birth centres, are being closed across UK or re-purposed for women who have COVID-19 or as isolation wards for non-maternity patients. Closures are affecting community-based, Freestanding Midwifery Units (FMUs) in particular. A survey of heads and directors of midwifery from across the UK, conducted by the Royal College of Midwives (RCM), has found that 21% of MUs have closed of which 11 units were turned into COVID-19 isolation units (2).

There is clear and well-documented evidence that for women with uncomplicated pregnancies, giving birth in a MU is safer due to lower rates of unnecessary intervention for the mother (3, 4). Birth in MUs is as safe for the babies of these women as birth in an Obstetric Unit (OU or hospital delivery suite). Providing maternity care for women with uncomplicated pregnancies in midwifery units has been shown not only to reduce unnecessary interventions during childbirth but also to decrease costs to healthcare systems and improve women ́s satisfaction of their birth experience (5-7). The current NICE guidance on planning place of birth for healthy women with uncomplicated pregnancies recommends that women are offered the choice of all four birth settings (home, freestanding midwifery unit, alongside midwifery unit, obstetric unit) and that women are advised that birth in a midwifery unit is particularly suitable for them (8).

In this exceptional situation we recommend that maternity services build on existing infrastructure, which includes out of hospital birth as part of the core provision and ringfencing and protecting AMUs in acute hospital settings. Services should expand the opportunity for women who are healthy and have no pregnancy complications to give birth in a midwifery unit as the default option, provided they have no symptoms of Covid-19. This will ensure that ‘low-risk’ women have access to optimal care and keep hospital obstetric units free for those with obstetric needs or medical need due to suspected Covid-19.

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MUNet Position Statement released on 31st March 2020

During this unprecedented strain on acute hospital services, supporting the obstetric unit and other hospital services, including ITU and anaesthetic services, involves avoiding the admission into higher level care such as the obstetric unit unless clinically necessary.

Maintaining, expanding or creating new MU services would benefit women, babies and services in two key ways:

  1. a)  Reduction in the number of obstetric interventions which put further strain on resources and staff and possible admission to high dependency or intensive care units.

  2. b)  Reduction in the risk of infection from hospital settings for women, their babies, their birth supporters and midwives skilled in midwife-led birthing care in MU settings.

During the COVID-19 crisis it is important to:

  1. Keep what works and is evidence-based: we recommend that maternity services should strategically re- open and increase activity in the existing FMUs by sustaining staffing levels and recommending and encouraging eligible women to give birth there. In a similar vein, we encourage AMUs within large hospitals to continue to open admissions to women with uncomplicated pregnancies, to operate as a ‘separate birthing space’ and to ringfence the skilled staff who work there to prevent re-deployment to the main OU to minimise coronavirus cross-infection risk.

  2. Create pop-up midwifery units where needed: where FMUs do not already exist, with collaborative planning and support, ‘pop-up’ FMUs can be created effectively and quickly, close to acute services (but in a separate building) following the example of the Netherlands (9).

  3. Utilise and mobilise midwifery skills appropriately: supporting a midwife-led, physiological birth outside of an obstetric setting is a skill with a defined philosophy (10). Home birth and caseload midwives have an abundance of skills which are well-placed in a MU setting. Independent Midwives (IM) may be able to support MUs if Trusts take the necessary decisions that will facilitate IM collaboration with NHS Trusts. Similarly, midwives returning to practice to help overstretched maternity services can be deployed locally in MUs and to give additional support in primary care settings as can midwifery students, doulas, experienced maternity support workers and other volunteers.

  4. Establish COVID-19 operational procedures for transfer from FMUs and homebirth: new emergency Standard Operating Procedures (SOP) can be established for supporting the safe transfer from FMUs to the OU. Firstly, the majority of non-emergency transfers can be facilitated by private transport or taxi. Secondly, in cases of emergency transfer there should be an escalation procedure involving private ambulance, the army or other alternative solutions. Services should be thinking seriously about those alternative solutions.

  5. Network and share knowledge: This epidemic is teaching us that we are all interconnected. We must learn from other services and other countries, share knowledge to maximise the spread of solutions (11).

We understand the difficult situation and ethical considerations our maternity services face at this current time. Maternity services need to be considered an essential service which should be maintained fully to avoid harm to maternal and child health in both the short and longer term. We need to join forces, strategically finding the best solutions for dealing with the current crisis. It is essential that throughout these difficult times we focus on our duty of care to women and their families. We need transformational midwifery leadership and lateral thinking.

Statement by Midwifery Unit Network Director team

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MUNet Position Statement released on 31st March 2020

For further information please contact: support@munetwork.org References:

1) International Confederation of Midwives (ICM) 2020 ‘ICM Official Statement’ https://internationalmidwives.org/assets/files/news-files/2020/03/upholding-womens-rights-during- covid19.pdf?fbclid=IwAR09_TGRpHZoj0gsWqRfWGonRC46kRldpYGd9YmoaCgnPeQBvk7d86pW5oU [Accessed on 30th March 2020].

2) Royal College of Midwives (2020) RCM Plea: help us deliver safe care for pregnant women.

https://www.rcm.org.uk/media-releases/2020/march/rcm-plea-help-us-deliver-safe-care-for-pregnant-women/

[accessed 31st March 2020]
3) Scarf, V., Rossiter, C., Vedam, S., Dahlen, H.G., Ellwood, D., Forster, D., Foureur, M.J., McLachlan, H., Oats, J., Sibbritt, D., Thornton, C., Homer, CSE. (2018). ‘
Maternal and perinatal outcomes by planned place of birth among women with low-risk pregnancies in high-income countries: A systematic review and meta-analysis’. Midwifery 62: 240-255
4) Birthplace in England Collaborative Group (2011). ‘
Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: The Birthplace in England national prospective cohort study’. BMJ, 343:(d7400)
5) Macfarlane, A.J., Rocca-Ihenacho, L., Turner, L.R. and Roth, C. (2014). ‘
Survey of women ׳s experiences of care in a new freestanding midwifery unit in an inner city area of London, England – 1: Methods and women ׳s overall ratings of care’. Midwifery 30(9): 998–1008.
6) Overgaard, C., Fenger-Grøn, M. and Sandall, J. (2012). ‘
The impact of birthplace on women’s birth experiences and perceptions of care’. Social Science & Medicine, 74(7): 973-981.
7) Schroeder, E., Petrou, S., Patel, N., Hollowell, J., Puddicombe, D., Redshaw, M. and Brocklehurst, P., 2012. ‘
Cost effectiveness of alternative planned places of birth in woman at low risk of complications: evidence from the Birthplace in England national prospective cohort study.’ BMJ 344, p.e2292.
8) National Institute for Health and Care Excellence (2014). Intrapartum care for healthy women and babies (Clinical guideline CG190). Available at:www.nice.org.uk/guidance/cg190 [Accessed on 30th March 2020].

https://www.knov.nl/vakkennis-en-wetenschap/tekstpagina/788-1/coronavirus/hoofdstuk/1357/coronavirus/ https://www.knov.nl/serve/file/knov.nl/knov_downloads/3396/file/20-03- 24_Draaiboek_fase_2_eerste_lijn_vangt_voor_elkaar_op.pdfhttps://www.knov.nl/vakkennis-en-wetenschap/tekstpagina/788-1/coronavirus/hoofdstuk/1357/coronavirus/ 10) Rocca-Ihenacho, L. (2017). ‘An ethnographic study of the philosophy, culture and practice in an urban freestanding midwifery unit’. Unpublished PhD thesis. London: City. University of London.

11) Nacoti, M et al (2020) ‘At the Epicenter of the Covid-19 Pandemic and Humanitarian Crises in Italy: Changing Perspectives on Preparation and Mitigation.’ NEJM Catalyst Innovations in Care Delivery [Accessed on 30th March .]2020

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9KNOV - Midwifery in the Netherlands. https://www.knov.nl/samenwerken/tekstpagina/489-2/midwifery-in-the- netherlands/hoofdstuk/463/midwifery-in-the-netherlands/

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MUNet Position Statement released on 31st March 2020

VIDM 2021 Closing Slideshow - First Cut